Zusammenfassung
Therapeutisches Ziel bei entzündlich-rheumatischen Erkrankungen ist die effektive
Hemmung proinflammatorischer Zytokine. Vier Antizytokin-Therapien mit eindrucksvoller
Effektivität sind gegenwärtig in Deutschland zugelassen. Anhand einer Literaturrecherche
(Pubmed) wurde der Frage nachgegangen, ob sich aufgrund einer unterschiedlichen Wirksamkeit
oder eines unterschiedlichen Nebenwirkungsprofils eine Differenzialindikation der
einzelnen Antizytokin-Therapien ableiten lässt. Nach der bisherigen Datenlage besteht
nur beim Morbus Crohn bzw. bei den enteropathischen (Spondylo-)Arthropathien eindeutig
eine Differenzialindikation, in diesem Fall für Infliximab als Mittel der ersten Wahl.
Trotz eines differenten Wirkungsspektrums der einzelnen Antizytokin-Therapien ergibt
sich bei allen anderen entzündlich-rheumatischen Erkrankungen keine eindeutige Differenzialindikation.
Bezüglich des unterschiedlichen Nebenwirkungsprofils der einzelnen Antizytokin-Therapien
ist bei fraglichem Tuberkulosekontakt eher das TNF-α-Rezeptorfusionsprotein als die
monoklonalen Antikörper zu bevorzugen. Mögliche Ursachen dieser Unterschiede in der
Wirksamkeit und im Nebenwirkungsprofil werden abschließend diskutiert.
Abstract
Therapy of chronic inflammatory rheumatic diseases is targeting on effective inhibition
of proinflammatory cytokines. Till now, four impressingly effective anti-cytokine
substances are established in Germany. Substantial differences in efficacy and occurence
of adverse events of these anti-cytokine agents were researched using a literature
data bank (PubMed) to work out different indications. The previous data bank only
pointed out a clear preference of infliximab in the treatment of M.CROHN and enteropathic
spondarthropathies. Although showing different modes of action different indications
for the treatment of the other chronic inflammatory rheumatic diseases could not be
detected. Concerning tolerability specially in case of Tbc-suspicion, the TNF-α-Inhibitor
etanercept should be prefered over the monoklonal antibodies infliximab and adalimumab.
Possible explanations of these differences in efficacy and tolerability were discussed.
Schlüsselwörter
Antizytokin-Therapien - Adalimumab - Anakinra - Etanercept - Infliximab - Wirksamkeit
- Nebenwirkungen
Key words
Anti-cytokine therapy - adalimumab - anakinra - etanercept - infliximab - efficacy
- adverse events
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Dr. med. Jutta Ernst
Chefärztin der Klinik für Internistische Rheumatologie, Rheumazentrum Oberammergau
Hubertusstraße 40
82487 Oberammergau
Phone: 088 22/9 14-2 61
Fax: 088 22/9 14-2 59
Email: jernst@wz-kliniken.de
